Bottom Line:
Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%).There were no major complications.Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.

ABSTRACTMinimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified "mini-open anterior spine surgery" (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24-52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12-L1, 18 at L1-L2, 18 at L2-L3, 22 at L3-L4 and 11 at L4-L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62-124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4-26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.

Fig3: A 74 year-old female who suffered from L1–2 osteomyelitis (E. coli). She received debridement and anterior spinal fusion with autogenous tricortical bone grafts through mini-open surgery. Two years later, there were no complaints or symptoms. Solid interbody fusion was noted, although the L1 screw migrated slightly (arrow)

Mentions:
Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 152 (67–285) min in the first year, decreasing to 85 (62–124) min over the next 6 years. Mean blood loss showed even better improvement, from roughly 425 (200–1,150) ml in the first year to 136 (minimal–250) ml over the next 6 years. The maximum reported blood loss of 1,150cc was related to the coexistence of mycotic aneurysm in a patient with infection; however, the patient was successfully treated by in situ graft replacement. Hospital stay ranged from 4 to 26 (mean 10.6) days. The Oswestry Disability Index indicated that nearly all cases showed improvement in back pain (87%), physical function (90%), and life quality (85%). These improvements were most pronounced in sitting endurance, standing endurance, living independence and sleeping quality. Most patients retained these improvements for at least 2 years. Grade of fusion, evaluated by plain film and dynamic radiograph, was solid in 48 cases (79%), probable solid in 10 cases (16%) and failed in 3 cases (5%) (Table 1). Most cases (95%) had solid or probable solid bony fusion without extra posterior instrumentation. Eight follow-up pyogenic spinal infections were clinically uneventful; five of these were fixed with one rod and two screws. One case had a noted slight upper screw migration, but without complaint (Fig. 3).Table 1

Fig3: A 74 year-old female who suffered from L1–2 osteomyelitis (E. coli). She received debridement and anterior spinal fusion with autogenous tricortical bone grafts through mini-open surgery. Two years later, there were no complaints or symptoms. Solid interbody fusion was noted, although the L1 screw migrated slightly (arrow)

Mentions:
Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 152 (67–285) min in the first year, decreasing to 85 (62–124) min over the next 6 years. Mean blood loss showed even better improvement, from roughly 425 (200–1,150) ml in the first year to 136 (minimal–250) ml over the next 6 years. The maximum reported blood loss of 1,150cc was related to the coexistence of mycotic aneurysm in a patient with infection; however, the patient was successfully treated by in situ graft replacement. Hospital stay ranged from 4 to 26 (mean 10.6) days. The Oswestry Disability Index indicated that nearly all cases showed improvement in back pain (87%), physical function (90%), and life quality (85%). These improvements were most pronounced in sitting endurance, standing endurance, living independence and sleeping quality. Most patients retained these improvements for at least 2 years. Grade of fusion, evaluated by plain film and dynamic radiograph, was solid in 48 cases (79%), probable solid in 10 cases (16%) and failed in 3 cases (5%) (Table 1). Most cases (95%) had solid or probable solid bony fusion without extra posterior instrumentation. Eight follow-up pyogenic spinal infections were clinically uneventful; five of these were fixed with one rod and two screws. One case had a noted slight upper screw migration, but without complaint (Fig. 3).Table 1

Bottom Line:
Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%).There were no major complications.Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.

ABSTRACTMinimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified "mini-open anterior spine surgery" (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24-52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12-L1, 18 at L1-L2, 18 at L2-L3, 22 at L3-L4 and 11 at L4-L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62-124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4-26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.